HomeMy WebLinkAboutPermitcAR F r ELD co uNry€
ï,'nili :,äi :ÎuHr
o N D E'ARTM ENr
cienwoodsprinss'""''iäãJãìuot Permit lZ'+'¿'
phone lnro¡ nou-ü1, Assessor's Parcel No'
INDIVIDUAL SEWAGE DISPOSAL PERMIT This does not constítute
a bui or use
PROPERTY
Owner's Name Present Address /2 Zâ CR 233 phone 7aV3e7Y
System Location
Legal Descripfion of Assessor's Parcel No'
SYSTEIVI DESIGN.
/-Z {A-sePtic Tank caPacitY
/7 7a +7
(gallon)Other
Z-f Percolation Rate (minutes/inch)Number of Bedrooms (or other)
RequiredAbsorption Area - SeeAttached ("13 5Q'ft, lN fV,¿r{c'{* ^s-z d-+=
Special Setback Requirements 13{ s4,,#ù -B,EP f êz Q-*s
DaÞ 3'-/8 '-/ I lnsPector
(as installed)
Callfor lnspection (24 hours notice ) Before Covering lnstallation
System lnstaller è4 L.
Septic Tank CaPaeitY ,/fo e
Septic Tank Manufacturer or Trade Name
Septic Tank Access within 8" of surface
Absorption Area þ
Absorption Area Type and/or Manufacturer or Trade Name
Adequate compliance with County and State regulations/requirements
e
lnspector
RETAIN WITH RECEIPT RE S AT CONSTRUCTION SITE
Other
Date 2 --ZZ-
GONDITIONS:
1. AIr instaration must compry with arr requirements.of the cororado state Board of Hearih rndividuar sewage
Disposal sv,i**t cnapiei 25' Artícle 10 c'R's' 1973' Revised 1984'
2. This permit is valid only for
"onnu"ìion
to structures which have fulty complíed wíth county zoning and
buirding requirements. connectíon t"
"l.
use with any dweiling or structures not approved by the Buirding and
Zoning office shart automaticary be a vioration or a requiremðnt of the permit and cause for both regar actíon
and revocation of the Permit'
3.Anypersonwhoconstructs,alters,orinstallsanindividualsewagedisposalsysteminamannerwhich
invorves a knowing and materiar variation from the terms or specifications contained in the application of
permit "ornri,, " ó1"", 1, petty offense ($500.00 fine - 6 months in jaíl or both)'
White - APPLICANT Yellow - DEPARTMENT